The One You Feed - Carl Erik Fisher on The History of Addiction

Episode Date: July 15, 2022

Carl Erik Fisher is an addiction physician, bioethics scholar, and author  He is an assistant professor of clinical psychiatry at Columbia University and also hosts the podcast “Flourishing After Addiction” In this episode, Eric and Carl Erik Fisher discuss his book, The Urge:  Our History of Addiction. But wait, there’s more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It’s that simple and we’ll give you good stuff as a thank you! Carl Erik Fisher and I Discuss The History of Addiction and … His book,  The Urge:  Our History of Addiction. Recognizing the paradigm of disordered choice in addiction The different approaches to understanding choices for addicts Psychological flexibility and how Society’s categorical views of treatment approaches to addiction Placebo effects in treating addiction The dangers of labeling “good” drugs and “bad” drugs Drug policies and why there is no simple formula for treating addiction How addiction is part of the human condition Defining recovery capital Understanding there are many different pathways to recovery The step care model and one size fits all model of recover The spiritual practice that he developed in recovery Knowing that the key to overcoming addiction is to try Carl Erik Fisher links: Carl Erik Fisher’s Website Instagam Twitter Facebook By purchasing products and/or services from our sponsors, you are helping to support The One You Feed and we greatly appreciate it. Thank you! If you enjoyed this conversation with Carl Erik Fisher, check out these other episodes: Recovery Through Buddha's Teachings with Valerie Mason-John Maia Szalavitz on a Different Lens on Addiction See omnystudio.com/listener for privacy information.

choose whatever variety of psychological suffering you want to, whether it's extreme depression or extreme anxiety or obsessional thinking or whatever, that's not neatly demarcated from the rest of humankind. For me, as a psychiatrist, when I can meet my patients or other sufferers who are struggling with those types of conditions, I can always see myself in them. Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like, garbage in, garbage out, or you are what you think, ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear.

We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor,

what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknowreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason Bobblehead. The Really Know Really podcast. Follow us on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Thanks for joining us.

Our guest on this episode is Carl Eric Fisher, an addiction psychiatrist, bioethics scholar, and author. He's the assistant professor of clinical psychiatry at Columbia University. author. He's the assistant professor of clinical psychiatry at Columbia University. Carl also has a podcast called Flourishing After Addiction and is the author of the book discussed here, The Urge, Our History of Addiction. Hi, Carl. Welcome to the show. Thanks so much, Eric. Thanks for having me. Yeah, we're going to be discussing your book, The Urge, Our History of Addiction. And as I said to you before we started, I have read a lot of books on addiction and recovery over the years, and I still learned a ton from yours. It's so good.

Before we get to that, we'll start like we always do with the parable. There's a grandparent who's talking with their grandchild, and they say, in life, there are two wolves inside of us that are always at battle. One's a good wolf, which represents things like kindness and bravery and love. And the other's a bad wolf, which represents things like greed and hatred and fear. And the grandchild stops and thinks about it for a second and says, well, which one wins? And the grandparent says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. Yeah. It has amazing personal resonance with me, in part just because we were hammered with it in art therapy class in inpatient rehab when I first got into recovery. And like many of these

things at first, we hated it. Me and some of the other physicians were in the program saying, oh, not these wolves again. But I eventually came to love it. So it has a personal resonance for me. But I also love the content of it and the message of it. I love the notion of being able to change your mind and train your mind through conscious, intentional action. I know that's a big theme of your show. And relevant to my work, there's even a prior insight that comes from that parable, which is the realization in the first place that we have a divided mind at all, that there are different parts in our minds. And that's beautiful. That's insightful and really actionable. For addiction, that's been a crucial way that thinkers have tried to understand self-control since the time of Aristotle, St. Augustine, the Buddha.

You know, I get into that pretty early on in the book that sometimes today there's this watered-down stereotype of addiction as being total loss of control versus supposedly healthy, totally free choice on the other. And in a way, the ancients did better at this by recognizing the divided mind and all of those varied ways that we could sometimes be divided against ourselves. Yeah. And we're going to talk in a minute about addiction and the different ways people have thought about it, the ways that we think about it today. There's lots of different paradigms, but one paradigm for it is this idea of it being disordered choice. You know, our ability to make choices goes awry, which to me, the

parable is primarily about choice, right? It says, hey, we have choices to make and they lead to certain outcomes. I too heard that parable in recovery very early on. And at the time, just really had a strong, strong resonance to me. Talk a little bit more about this disordered choice. strong resonance to me. Talk a little bit more about this disordered choice. Choice has become sort of a dirty word in addiction and recovery, and not without good reason. Going back hundreds of years, people have enacted stigma and stereotypes against people with addiction by saying, oh, it's just a choice. It's just a vice. People are addicts by their own choice, or they're choosing to be this way. And that's really limiting and dangerous because it paints people with addiction as if they're consciously hurting

people or hurting themselves. At the same time, I think in the contemporary discourse, we've lost some of the richness of choice and the way that choice actually is operative in addiction. Most people who have an experience of addiction know that there's very complicated and really active choice involved sometimes, even in the worst stages of addiction, that people can have a sense of being an agent, being someone who chooses, planning to support their addiction and other activities related to it. And we lose a lot if we revert to that old stereotype of people as if they're hijacked or depersonalized or just being led around by an addiction that is somehow stronger than them. I think the first step is just recognizing that disordered choice is a useful

paradigm. And I think it squares with at least my experience of addiction and many of my patients' experience of addiction, that there's something about choice that matters. I agree. I've thought about this question a lot. And the question really is to what degree do addicts have choice at different stages in their recovery or addiction? Because I had a choice not to use heroin. I had it then, I have it now. It is a very simple choice right now, right? It's almost not even a choice, right? It's just not even there. 25 years ago, it felt like the amount of choice I had was so slender.

And that's, to me, one of the frustrating things about addiction, even having been around it for so many years and having friends that are in it, that there's this part of you that wants to go, but just don't do it, even though I know how hard that is. And at the end of the day, it does come down to, you do have to choose not to. So what are some ways that you can think of to give people more choice, the ability to make better choices, you know, if they are caught in addiction? What are some of the things we know about that? I love the way you phrased that question, because it's not just the individual. Choice can sometimes imply that it's all up to me. It's an individualistic project of self-control. And that's not true. In my own case, in my own

story, I got the opportunity to pursue recovery because I was situated in the middle of a physician health program, which is a special kind of program thaties for other situations. Some of the best evidence we have right now for methamphetamine addiction, which unlike opioids doesn't have good medicines to treat it, is something called contingency management, where people as part of a psychotherapy process are given rewards if they pass certain milestones, if they have a urine test that doesn't have substance of abuse in it. And a lot of people balk at that. They say, what, you're paying people to have an abstinent urine? That doesn't make any sense to me. But it's the exact same situation as, say, a husband and a wife might get into when someone's getting a tough choice. That's a form of informal coercion. Of course, this can be done

unhealthily, but it can be healthy too. I need you to get help and to make a change. Otherwise, I can't stick around. And people are responsive to choices. Sometimes that works. Sometimes it doesn't. As we know, a lot of times, tragically, that sort of informal pressure doesn't always work. But again, thinking of choice as something that's operative in a social network, in a relational network, in a community, in a societal network, is really important. And to think about how can we set people up to make those tough choices more possible, more supported, more likely to lead them. What I think every human being is naturally inclined toward, which is flourishing, is some form of happiness or satisfaction or freedom from pain.

Right. You talk about addiction, you say some people insisted that addiction was primarily a brain disease. Others claim that this brain-centric view blinded us to the psychological, cultural, and social dimensions, including trauma and systems of oppression. One summary of theories of addiction listed no fewer than 30 different models. We're not going to obviously solve what addiction is in this conversation, but do you have a short working definition for you of what it is? Yeah, my definition is more literary than it is scientific or theoretical. Because today in 2022, I don't think that we have something scientifically speaking that encapsulates the whole experience of addiction, that explains

it across all the necessary levels in the kind of reductive, straightforward simplicity that we might want. So I really like the 16th century definition of addiction when it first entered the English language. It's actually a philosophical and a theological term that early Protestant reformers got attracted to. They loved this term because they thought it pointed towards something mysterious about the human condition. Protestants in particular are very interested in the notion of sin, free will, choice, control. And as they were writing up theological texts during this time of religious formant and energy, addiction was something that was suggestive of a gray area between free will and powerlessness. It meant something like voluntarily giving up choice, a choice

to give up choice, or a devotion is a word that's often associated with addiction. I think that addiction is something universal to the human condition, in fact, just in greater or lesser portions. I always shy away from definitions that try to establish a dividing line between so-called healthy and not. So I just think of it as a powerful devotion that takes away power. Interesting. Yeah. It seems to me that it's a little bit like depression or other mental illness categories. We talk about them as if they are this discrete thing. And they are much more like, I don't know if this is the technically correct word, but to me, it, that the number of variables that go into causing an addiction are, I mean, who knows how many there are? There are so many. There's our genetics, there's our upbringing, there's our society that we're in, there's the people we hang out with,

there's the drugs that we actually take, the substances themselves, there's the culture we're in. There are so many factors that are each so complicated that to try and understand why is so difficult. People often ask me that question. Well, why do you think you started doing that? I'm like, I mean, I can tell you some theories about how maybe I didn't get certain needs met when I was a child. But the honest truth is, I don't know. We can't figure this out exactly. Thankfully, we don't have to tweeze it all apart and understand all the causes and conditions to find our way towards recovery, or we'd be in really deep trouble. Exactly right. I've always liked the pragmatic traditions around personal development and change

and community support. A lot of today's traditional recovery supports, including 12-step groups, are like that. There's a focus on pragmatism and not so much navel-gazing or trying to come up with some story or explanation. We also find that in William James's philosophy, which was very influential on certain other strands of understanding addiction in the States. We also find that in other spiritual traditions. In any sort of mystical tradition, I think there's a tendency to turn away from the metaphysical. You know, for me, my main spiritual path is Buddhism. So I'm not a teacher, but as I understand it, the Buddha was very rigorous about saying, listen, don't spend your time wondering

about the arrow. Don't ask me if it's made with a goose feather, dove's feather, I don't know how people make arrows. Let's focus on the wound. How do you get better? What is actually going to help in this moment? And just like what we were talking about with a broader view of addiction, I think that's about human suffering and psychological flexibility. It's not specific to addiction or not. It's all on the same spectrum as part of the same set of syndromes, as you put it. Yeah. You often talk in the book about how addiction seems to be a matter of degree rather than kind in that we all could have it. We could all be somewhere on a spectrum of having it. And I love this. You say addiction is just the place where our universal human vulnerabilities are most clearly on display.

Yes. It's a beautiful sentence. Well, thank you. I got it in part from the writing of Richard Rohr, who I think returns to it over and over again, this notion in a variety of his writings. And other psychological thinkers too, like Stephen Hayes, the founder of ACT, Acceptance and Commitment Therapy, a similar angle on the same notion that choose whatever variety of psychological suffering you want to, whether it's extreme depression or extreme anxiety or obsessional thinking or whatever,

that's not neatly demarcated from the rest of humankind. For me, as a psychiatrist, when I can meet my patients or other sufferers who are struggling with those types of conditions, I can always see myself in them. Even though I've never had some sort of debilitating depression on its own, apart from substance use problems, I've never had panic disorder. But the same processes, the same sort of psychological inflexibility and the attempts to modulate or escape from our pain are there, just in a different flavor. modulate or escape from our pain are there just in a different flavor. Yeah. I love that term around psychological flexibility. We've had Steven on the show a couple of times and he's so good. That term of what we're after is psychological flexibility, I think is such a useful term. So there are four broad approaches that you talk about that people have used to think about addiction and substance use disorder in those responses, we could see the governing model of addiction. They were sort of a nice reflection of how a society made sense of problems of addiction, whether it was the first opiate epidemic in the United States in the 1860s,

or whether it was the gin craze in the UK in the 1720s. That was one of the big surprises of the book, that human societies have had these drug epidemics over and over and over again. So I was interested in what societies do, how do they try to help, and how do they fall short, what works, what doesn't. So just really quick, the four categories that I came up with, which overlap and blend into each other at times, are therapeutic, mutual help, reductionist, and prohibitionist. And therapeutic tends to mean that there's a medical model, a sort of psychotherapy or other sort of professionalized response. Reductionist is related but different in that a scientific

cure or some sort of basic biological discovery is supposed to eradicate addiction. Mutual help is interesting because not just in the case of 12-step groups, but at various other times in different societies, there's been predominantly a bottom-up grassroots community level response to addiction. We can talk about that more if you want, but analogous groups in the 1840s or even in Native American communities around the time of the American Revolutionary War, with striking similarities to today's mutual help groups, but totally separate. No lineage that I could find connecting them. And then the last is prohibitionist. And prohibitionist means any supply side, law and order, criminal justice method of trying to stamp out addiction. And the thing about all these responses is that no single one of them works. We need a little dash of each of them for the best responses

to addiction problems. But unfortunately, societies tend to have short memories and limited attention spans. And so unfortunately, it's been more common that we've swung from extreme to extreme to extreme, that there's been too much faith in a therapeutic approach alone. And then when people get disappointed, it swings back around to a prohibitionist crackdown and so forth and so on. Yeah, you make the point throughout the book that there are opportunities where these different approaches or these different views of addiction could work together, but they usually don't. You know, one that comes to mind

is recovery that insists on abstinence versus recovery that is more a harm reduction approach, and that they could blend and they could work together and they could coexist, but people get divided into their camp. You know, this is the right way, this is the right way. And I think something as often as personal as addiction can be, whether it's yourself or people you loved, brings about really strong feelings and really strong feelings don't lend themselves to us thinking about things in a nuanced way, which is what we need, I think. Yeah, the ideological divisions are so strong across different dimensions of human behavior, whether it's the mutual help oriented sort of divisions or even huge divisions within AA as it developed.

That was another fun surprise. And a bunch of that didn't even get into the final book. But people had really strong opinions about, for example, how do we revise some of our core literature or not? And likewise, at the societal level right now, there's such battles over what I think are ultimately false divisions. And it sounds like you do too, that there isn't some sort of natural essential conflict between what we usually mean when we say harm reduction and abstinence-based recovery. Those two things can work together. The problem is when somebody says abstinence only,

that's the only way to recover, for example. Because we know a lot of people don't want help or they receive help and then they have trouble maintaining abstinence. And for so much of modern medicine's history, we've had a lot of trouble meeting the needs of people. Some researchers have called this the underserved majority, meeting the needs of people who are not ready to stop, or maybe even their use is kind of mild to moderate, and they're not sure that they have a full blown addiction. And so we need flexibility. And that's not incompatible with abstinence, because you meet people where they're at. And then eventually, a lot of people do make it to abstinence, you save their lives, you give them the opportunity to engage with care. And some people will and some people won't. A lot of times, the ideological divisions, I think, are just a fiction. They're just a construction. I was, as I like to say, raised in the 12-step tradition, right? So I came out of that with certain beliefs about the way recovery works. And I'm pleased to say I've had my mind changed about most of that over the years. Not my mind changed as far as that the 12-step

approach isn't useful because it saved my life and lots of people that I know. But to think that that's the only way that works for people, or it's the best way, or that everybody needs to go that way is arrogant. And even early AA writing says, that's not true. We're not the only way to do this. Yeah. One of the things I found in the historical research is that arrogance that 12-step groups should be the only way is a historical accident. It's not because there's some secret cabal, as far as I know, of the AA leaders, which doesn't even have leaders, by the way. It's not that this is some secret cabal back pulling the strings to try to convince everyone to sign

on to some sort of program. It's that the medical profession, for a variety of complicated reasons, basically abandoned the treatment of people with addiction back in the earlier part of the 20th century, say around like 1910s, 1920s, a group in the American Medical Association said, opioid addiction is a vice. It's not a disease. It's not for doctors to treat. Forget about them. And then that vacuum continued. And we had to deal with that vacuum into the 1960s, even into the 1970s. And we're still playing catch up today, where thankfully, there are a lot of great addiction medicine counselors and doctors and psychologists who are trying to play catch-up, but still we have this funny

system where addiction care is for some reason segregated from the rest of medicine or even mental health treatment. And in that vacuum, certain extreme beliefs got exacerbated and people needed something to hold on to in the absence of the kind of appropriate support that maybe medicine or science could have provided. And so it got very polarized. I think from where I sit and sort of like the front lines and seeing some of the policy nowadays, there's a lot more integration and there's a lot less of that ideological division now. And that gives me a lot of hope. But of course, we still have the legacies of some of those ideological divisions.

So there's obviously lots of different approaches to treating addiction. We talked about sort of four broad approaches. One of them is the reductionist approach. And I can't resist getting this story in here. Because, you know, when you have a reductionist approach, you think it's just this thing. and, you know, you could take a pill and fix it, right? And you say that unending processions of would-be heroes have proposed endless bizarre treatments founded on overconfident reductionist theories. And though it's a crowded field, Leslie Keeley, a 19th century addiction entrepreneur, probably takes first prize. Tell me about Leslie Keeley. Thank you for asking, Eric. I don't think anybody else has asked me that in all of my press interviews, but I think he's such a fascinating, fascinating

guy. So Leslie Keeley has a sort of shadowy past. I don't know that he's a doctor or not. We don't know a lot about his upbringing, but he came to prominence during a time in American medicine, latter part of the 19th century, let's say like 1870s, 1880s, so forth and so on, when there was a lot of marketing, a lot of self promotion, and a lot of miracle cures. We didn't have an FDA back then. There wasn't any regulation. Most things that we would consider pharmaceutical compounds, people could just buy via mail order, just by walking into their local store. And Leslie Keeley came up with this thing called the Gold Cure, which apparently didn't have gold in it, but he did a sort of mail marketing, mail like M-A-I-L marketing, though I'm sure a lot of his clients were

mail too. And it got really popular and he made a lot of money. And then the innovation that he did was to build on the success of that Miracle C cure and build out this whole network of what we would call inpatient rehabs today. And a special cure that you had to come to his treatment facilities to get, which involved a red, white, and blue syringe that people would just line up and get injected. It's all nonsense. It's all nonsense. It's all nonsense. But the part that's not nonsense, actually, is that whether it's because of a real sense that it would be helpful, or if it was just some sort of beneficial side effect, he also helped people to band together in mutual help groups. And so probably the only thing that he did that was useful, aside from raising the profile of just

the problem of addiction, is that he organized these things called Keeley Leagues. He did it because it was marketing. He told everybody, once he left his institutes, to say, I've been to Dwight, because Dwight was the town where his main institute was, and wear a little badge on your lapel and tell people about all the great treatment you got from me. But what that also did is it encouraged people to band together and share their experiences and support each other once they left his treatment facilities at a time when there wasn't a very robust mutual help tradition.

There was one in the 1840s, but then it kind of fell away, and we were decades before the rise of 12-step groups. And that was actually a really useful thing for a lot of people who went through his treatment, so the syringe notwithstanding. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like

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And you never know who's going to drop by. Mr. Brian Cranston is with us today. How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. Bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really No Really. Yeah, really. No really. Go to reallynoreally.com and register to win $500 a guest spot on our podcast or a limited edition sign Jason bobblehead. It's called really know really and you can find it on the I heart radio app on

Apple podcasts or wherever you get your podcasts. I assume that some of these things what we would consider a wacky cure, that there's some degree of placebo effect that goes on there. I would have to imagine that some of the times that's with the disease of addiction. I'm going to take that word back. I'm going to strike that. Condition-like addiction that's so psychological that the placebo effect probably actually there's something to it. What did you find around that? Any thoughts? Well, I know for a fact that the placebo effect is very powerful. There are great researchers and clinicians who are studying this today. Some folks up at Columbia doing neuroimaging on this subject and forget about mental distress. There's placebo effects on physical ailments because there's no real division. For example, that the mind is what the brain does, at least as a starting point, then mental things will have an impact on your body, including stress and the balance of fight or flight versus rest and relax. I mean, we could have a whole episode on those sorts of topics.

But there are plenty of ways that cures or other treatments that we would say from today's perspective, no way that that's helpful, still had some sort of effect. perspective, no way that that's helpful, still had some sort of effect. And I think it's partly placebo, but it's also because people practiced, you know, getting back to the title of your show, that they directed their minds in an intentional way toward the good. They brought their focus to the addiction. They asked themselves this question that we tell people to ask themselves in psychotherapy about addiction, which is, what am I actually getting out of this? What is this doing for me? You know, whether that's the Keely cure, or any of these other like horse pills, or another one is an immunological treatment where they made, they basically got horses drunk, and then withdrew their serum and then injected that into humans because they thought maybe addiction had something to do with immunology. All that stuff is bunk. But at least in the cases where it's not actively hurting the person, it's still a ritual. It's a ritual that directs

people's attention to the problem and helps them to wake up to how they're relating to their mind. My favorite Keely cure that Chris and I have been laughing about all week is the White Star Secret Liquor Cure. 94 cents for a box of 30 cocaine capsules. Yeah. So we can put that in the column of ones that are not helpful, probably counterproductive. Yeah. Yeah. Somewhere else in the book, you talk about someone else who thought cocaine was a cure for morphine addiction. And Chris is a recovering cocaine addict, among other things. He's like, I think I'm going to go get a morphine addiction so I can start doing cocaine again. Yeah. Both at the same time time as it often worked out.

That's right. Yes, that was something I greatly enjoyed. Anyway, let's talk about good drugs versus bad drugs. What does that mean? Yeah, throughout history, people have sought to divide up drug users by supposed good drugs and bad drugs. Usually that's about the groups or the types of people who are getting the attention. Certain types of drugs are associated with the supposedly wrong sorts of users. Others are associated with the right sorts of users. Some of the classic cases are at the end of the 19th century, let's stick with the end of the 19th century, smoked opium was considered a Chinese drug, because there were a lot of Chinese immigrants, especially on the west coast of the US. But morphine pills were considered a sort of upper class white drug. And people treated the smoked opium as if it was more dangerous, even though injected morphine can certainly pack a much bigger punch. So in that example,

in many other examples, we see how dangerous that division is. To divide up drugs into good drugs and bad drugs allows ideas about drugs and addiction to be used as a weapon on one hand, but it also misses out on the true dangers of addiction on the other hand. Then the misguided ideas about addiction come back to hurt all of us. And that happened over and over again when we overestimate the harms of certain drugs, but then almost invariably underestimate the dangers of others. In a way, that was a major, major factor in the development of today's opioid overdose crisis, that opioids were a good drug. And they were a good drug in part because at that time, crack cocaine was a bad drug. I have a quote in the book about one dopamine researcher who said in the 1980s, if I had a choice about whether my daughter could use either cocaine or heroin, I would choose the heroin, which is mind boggling today. Nobody would say that today in 2022.

And this is a good researcher who later moderated some of his statements to his credit. And so I say that not to knock him, but just to illustrate how powerfully our scientific ideas and our medical ideas about addiction and drugs can be influenced by the social and cultural context. We would like to think that it's some sort of objective, quantitative science, but we can't escape from the cultural and social baggage. Right. You say that this is a double-edged sword causing great harms on both sides, destructive and ineffective drug wars on one side and lax pharmaceutical regulations on the other. I think that's one thing that was really helpful to me early on in my recovery

was they just said all the time, a drug is a drug is a drug is a drug. I was like, well, cough medicine is just as dangerous to me. Maybe not just as dangerous, but cough medicine is not a good thing. Here's a story. I don't know if I've ever told this on the show before. I've told a lot of stories too many times. My brother and I, I don't know where we got this idea, but we've heard somewhere that if you drank like an entire bottle of Robitussin and then took some other cold medicine with it, it was called the lizard. And yeah, and it kind of made you feel like a lizard. It was actually a fairly apt description of how you felt after you did it. But a drug is a drug is a drug is I think kind of what you are saying here. And you're also talking about the

ways in which we have used drug policy to stigmatize certain segments of society. Yeah, that's such a common thread. It's a little bit disheartening. But I think recognizing the way that history rhymes with the use of drug policies as a weapon helps us to take some of the stigma and the ideology out of the whole picture. One example is in the 1930s when cannabis was villainized and Harry Anslinger, who is this famous figure in drug prohibition, basically the founder of the organization that eventually became the DEA. He didn't care about cannabis. It's very well documented. He didn't care. But he saw for a variety of reasons, including the South and Mexican immigration, that cannabis was politically

ripe. And that's the way that he could build his power and build the rest of his career. It even happened back in the first tobacco epidemic in, say, the 1500s through the 16th century, that the wrong sorts of users were considered the sort of lower class tobacco users. And they were threatened with excommunication and death. And in Russia, they had their nostrils slit. And none of that stopped people from using tobacco because as we know from cigarettes today, it's a hard one to kick. But the association with the supposedly wrong sorts of users extended all the way to the English king saying, oh, it's just like the barbarous, beastly and slavish Indians that you're basically like beasts. You're not even full men, according to the sort of racist logic of that time. And that's

a great example because they didn't have a concept of addiction back then. So we don't even need an idea of addiction to associate these sorts of caricatures of the dangers of drugs. People have been doing it for hundreds and hundreds and hundreds of years. So given all the research you've done, and you just mentioned to me that you're in Portugal for a couple of reasons, but one of them is to understand that, you know, some of the drug policy there, what is reasonable drug policy, right? Because on one hand, you know, we've seen prohibition doesn't really work. A war against drugs doesn't really work. Is the other extreme, there's no regulation? Do you have an opinion at this point of what sensible do is misleading. Starting from first principles, I think the first principle has to be that we won't see the end of addiction, we won't see the end of drug use.

And that usually attempts to eradicate it through some kind of technocratic drug policy have caused more harm than good. That was true back when people were slitting nostrils for tobacco use, and that's true through the 1980s, 1990s, and till today. It's not to say that there aren't things that we can do today, because there are. It's not to say that there aren't things that we can do today, because there are. There's so many simple things that we could do to save lives. We desperately need to expand addiction treatment while also improving the quality of addiction treatment so there's not so much chicanery and just outright nonsense. We need to expand sensible evidence-based harm reduction programs, which are proven to save lives without increasing drug use.

And if everybody got all their wish lists of those simple strategies to save lives, there would still be addiction. And so any drug policy that's founded on the notion that we can somehow stop addiction, eradicate addiction, has lost before it started. Already misleading. eradicate addiction has lost before it started already misleading. But you asked about Portugal. I mean, one of the really ripe questions right now, especially because Oregon is also experimenting with this is the notion of decriminalization, which means different things to different people. It's worth doing. I mean, not necessarily me right now today, but it's worth doing a deep investigation into what decriminalization actually means, because it means different things in different places. And sometimes the Portugal experience is presented as if in 2001, Portugal waved a magic

wand, they decriminalized drugs for personal use, and then everything got better. And the truth of the matter, as I'm finding more and more and more each day, is that the decriminalization was one of the least important parts of the Portuguese policy. There may be very good reasons to carefully decriminalize drug use for personal possession. That by itself is not what lowered Portuguese overdose rates, and it's not what by itself lowered Portuguese rates of harmful drug use. They also made massive investments, not just in quality treatment, but in just general social care, making sure people had housing, making sure people had access to meaningful work, and to make sure that people weren't stigmatized and criticized and certainly not saddled with

some awful criminal sentence just because of using a drug related to their addiction. I don't want to speak against decriminalization, but I also don't want to say we should enact it as a blanket policy because the devil's really in the details here. You say we will not end addiction, but we must find ways of working with it. Ways that are sometimes gentle and sometimes vigorous, but never war-like because it's fuel to wage a war on our own nature. That's a very elegant sentence there to sort of sum up some of what you're saying, which is, hey, addiction is part of the human condition. It's not going away. And some of our policies might be more gentle.

Some of them might be more firm. But to think we're going to get rid of this is to miss the point. It's to profoundly misunderstand what we're dealing with. There's another line you have that I think is so good here. And you say, addiction is profoundly ordinary, a way of working with the pleasures and pains of life. It's this part coming up that is so good. And just one manifestation of the central human task of working with suffering. And so none of us are foolish enough to think we're going to get rid

of human suffering. It's just not going to happen, right? I think a clear-eyed view is the same with addiction. It's not going away. As long as there are substances, there are people who will use them in ways that are destructive. I just think that's, it's kind of baked into us. We'll use cake in ways that are destructive. We'll use gambling and sex and you name it, video games, right? We have the capacity to use things in ways that are not good for us. It's endemic. Yeah, really well put. That's exactly right. That's exactly in line with what my views are at the social level, that there will always be some people who use drugs in a way that's harmful to themselves and others. And also at the individual level, that even after someone

achieves some measure of abstinence from, say, a certain problem substance or they enter recovery in some way, that doesn't mean addiction's gone. I see it in myself, in my own recovery. You mentioned cake. I'm not a cake guy. I'm an ice cream guy. But the goal for me today in my recovery is not some sort of perfect mastery of all of my urges and cravings. I could say a lot of goals, but this is not my therapy session. I'm saying my vision for recovery is more friendly acceptance and facility in dealing with the difficult feelings. And I don't think that ends. I don't think that stops. You know, I've talked to monks who have meditated for 40 years in silent retreats and serious practice in whatever tradition. And, you know, they're not floating around in the cloud. Even the ones who seem very content and happy and joyous, they,

you know, maybe have gotten a lot out of that. But it doesn't mean that you're just some robot that exists without suffering. That wouldn't be a life worth living, if you could somehow eradicate that kind of feeling. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer.

Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you and the one bringing back the woolly mammoth. Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never know who's going to drop by. Mr. Bryan Cranston is with us today.

How are you two? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. God bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really No Really.

Yeah, really. No really. Go to reallynoreally.com and register to win $500, a guest spot on our podcast or a limited edition signed Jason bobblehead. It's called Really No Really and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. Let's turn our attention for a few minutes to your recovery, because I think there's some things in there that I'd love to talk about. One is, you alluded to it earlier,

how, to use the word we use today, you had a lot of privilege, which meant that as a white male doctor, you were given treatment options that were really good. I am similar. I was a homeless heroin addict, so I was not a doctor. I could never achieve that level, but I was a white male who had been raised in an upper middle class place, and I was given options that so many people I was around as I went through my treatments and stayed in halfway houses, options that so many people were simply not given. This speaks to an idea that's become prominent, which is the idea of recovery capital. Can you share a little bit about what recovery capital is? Yeah, I love this notion of recovery capital, because it's so flexible and all-encompassing. And I suppose the broadest definition of it is anything in a person's life, psychological resources, concrete resources, family, friends, relationships, job, so forth, that supports the recovery. And we don't all start from zero, and we don't all enter recovery at zero. Some people have a lot of recovery capital,

and some people have next to none, or almost none. And like you were saying, sometimes that's a function of what the person individually has, like having enough money in the bank account, literal capital to afford expensive treatment. And sometimes that capital might be more at the level of ideas and perceptions and stigma. Certain people are not afforded the same sorts of privileges or access or second chances or third chances or fourth chances. People who use certain types of drugs. I was primarily having a problem with alcohol and primarily a problem with prescribed stimulants. And even into my early recovery, it was really

important to me that I told you that I was using doctor prescribed stimulants. I wasn't a bad boy. I wasn't off running and buying my stimulants on the street as if that made a difference. Identity and the sort of ways we present ourselves to the world can be misleading and a source of denial and a confusing thing. But also sometimes it really has concrete effects that if I can present myself as the right sort of person with addiction, maybe I get more opportunities. And who knows? Who knows what would have happened if, you know, choose any dimension of that recovery capital. If I didn't have it, what would have happened? Even in my early days of treatment, I was sort of rebelling against it and saying, well, I'm not sure I'm really an alcoholic. And I think what you're saying is pretty dumb. I'm a psychiatrist

and I know better than you counselors and so forth and so on. And yeah, under different circumstances, I might've just gotten kicked out of the program and then I'd lose my medical license or at least it takes me years and years and years to get it back. You know, for me, the phrase that I always think of in reference to this is an accident of birth. I'm in recovery now because of an accident of birth. I also had a problem with addiction because of an accident of birth. But that forces me to be humble and grateful for what I do have and what I had the opportunity to pursue. You talk about how you were in recovery and you felt like you weren't doing enough recovery. You felt like you weren't doing it right. Talk to me a little bit about that

and how you sort of came out of that. When I was sent to treatment, it was a fairly old school, 12-step oriented program. Meaning for some, but not all people there, 12 steps were presented as the only way. And for some, but not all of the counselors there, medications were a bad thing. There's something that's not quite clean about needing to be, or even choosing to be, on a medication that helps with addiction treatment like buprenorphine or methadone. Along with that, there were some, I think, ideological notions about how you recover. And when I went back and I did the research, I saw these notions echoed in quotes. And even the head of a major rehab in the 1980s said,

I can guarantee you if you don't go to AA after you leave here, you won't make it. It's false. We have very good data that shows that maybe it's dangerous, maybe it's not right for everyone. But a lot of people with even severe substance problems can return to moderation. And again, I don't want to be cavalier about that. I don't advise people to go out and play games, especially after they've had a severe substance use problem. But we also know that there are many different pathways to recovery. As I'm sure you know, is a big buzzword right now in addiction treatment, respecting the many different pathways to recovery. But I had never heard that concept

or never learned about it in medical school. I'd never learned about it in my psychiatry training. I never learned about it when I was at rehab. And I think that does people a disservice because kind of like what we were talking about earlier with an abstinence-only ideology, we have to come to terms with the real world. What happens in real life is that people will go on a variety of different pathways. And even if we don't know that they're on the right path, we have to meet them where they are if we want to give them the best chance, if we want to give ourselves the best chance of supporting them in those pathways. So you're asking about shame, what I might call the internalized stigma of recovering in the wrong way. I got a lot of messages like, if you don't do a 90-90, and if

you don't get a sponsor right away, and if you don't start doing service, and if you don't do this and you don't do that, then you're going to relapse, and I'm going to see you back here again. If you don't do this and you don't do that, then you're going to relapse and I'm going to see you back here again. And I didn't do everything by the book at first. And guess what? I didn't relapse. And I got through it. And it was actually learning about and getting the opportunity to recover along those more flexible lines that gave me the space, the psychological space to come back and appreciate more of a 12-step pathway and appreciate more the kinds of things that I think the best kind of 12-step activity are trying to promote, like developing a spiritual practice and finding a community and all the rest. I think that

when we're too rigid and too ideological, and by we, I mean like addiction treaters and otherwise, when we're too rigid and ideological, then we push people away from exploring things with one's own agency and finding one's way back to what actually works. Yeah, I think even within a 12-step fellowship, let's just take AA, even within AA, the way that it's presented can be radically different. You could come here to Columbus and you and I could go out on a Wednesday night and hit three different meetings and get three potentially very different views on how you recover in AA. One meeting would say exactly like you said, every word in the big book is the literal word of God and you've got to treat it exactly right. And if you don't go to 90 meetings, if you don't go to a meeting every day, you're going to die. And then you could go somewhere else. It's a whole lot more like, you know, the 12 steps are suggestions and

we're here for you. And, you know, and everybody's got to find their own. I find it unfortunate that a lot of people who are looking for help can go to a certain type of meeting and get turned off to the whole thing. By that, I always say to people, if you're going to try AA, like at least just give it like five different meetings. Before you rule it out, go look around a little bit. You know, one way that I think about this, and I'm curious what you think, you mentioned in the book, and I don't remember what you call it. It's something like a stepped approach to recovery. You start out by doing a little bit of something. Step care model.

Step care model. I often think that that is a really wise way, whether you're being treated by a physician or you're looking at recovery on your own, is sort of a step care model. Like, all right, here's what I'm willing to do for recovery today. Did that work? If it did, then maybe I found what works for me. If it didn't, then I probably need to look at getting some more support. Now that could look lots of different ways, but it tells me that I don't have enough recovery support in my life. So I need to step it up. Does that seem like a reasonable way of thinking about it in your mind? Yeah, absolutely. Absolutely. And some of those diverse views within AA, I think are at least in part a legacy of historical developments through the mid-20th century.

And I needed that for myself to understand what's going on with our treatment system. Why does it seem so screwed up? Yeah. Why is it so hard to access quality care and why is it so ideologically driven? care and why is it so ideologically driven? A lot of those, I think, more hardcore ideas about 12-step recovery are more a function of the treatment system. And one former senator and even AA member himself, Harold Hughes, called the treatment industrial complex. He helped to establish the whole thing. And then later in life, he said, this is getting dangerous. You guys are too ideological. Probably mostly guys at that point. And it was really important to me to untangle the threads of that sort of one-sized fits all

treatment system versus mutual help recovery. Because I think they're different things. And there can be lots of overlaps and lots of interconnectedness because a lot of people who are counselors or working in rehabs are also in mutual help. But these are distinct things. The treatment system is different than mutual help recovery. Because of that, and because of the way the treatment system evolved, we wound up with a one-size-fits-all model. And that's still primarily how care is delivered. The sort of folk psychological idea of what you do if you have an addiction problem is go away to rehab. But that doesn't make sense. You know, we had cases in the 1980s when people would just get a couple

DUIs and they would be forced to go to an inpatient rehab. That's preposterous. Right. We don't treat other mental health problems that way too. It's not like, oh, you're a little bit sad. You had a crying spell yesterday. Go away to inpatient psychiatric hospitalization. It doesn't make any sense. Every listener of this show would have been just put in an asylum by that criteria. Yeah. And you wouldn't tell anybody because you'd be scared. Yeah. Which is a big part of all of it too. So, you know, that one size fits all model

is almost like a remnant of that American medical abdication of its duty to help people with addiction. And so we're still making up for lost time and still trying to come up with something like the step care model where you meet people where they're at. And if somebody is, say, not too dangerous and they're not that interested in treatment, then you engage at a lower level. It doesn't preclude you from offering higher levels of care. Somebody comes in and they say, I've got abscesses up and down my arm and I've overdosed three times and I'm worried I'm going to die. Please help me. Then, okay, fine. Maybe inpatient care is right for that person, but it's not necessarily right for everyone. Right. Yeah. In the same way, if I went to my doctor and like you said, said I was feeling a little bit sad, we would not immediately move to electroconvulsive therapy, right? Like that's going to come way down the road. Not that it's not a valuable treatment because it is for some people, but it's certainly not a starting point. And I think this is so interesting because it gets back to the moderation piece a little bit, which is this idea that not everybody needs abstinence, which I think is unquestionably true.

That's not necessarily the starting point. Now, that becomes tricky because it's also the thing that every one of us as an addict wants to believe is true. Yes. Right? It's the thing that every one of us that needs abstinence wants to believe. I thank my lucky stars. I got sober at 24 from heroin, stayed sober about eight years, went out and drank again, started drinking, never went back to heroin, started drinking smoking pot for about three

years. And I've been back sober 15 years. But before I did that, I did not want to come back to 12-step recovery. I did not want to come back to abstinence. Desperately did not want to. So I went to moderation management, which is a program. And I've told this story before. And I would have been the valedictorian of moderation management if it came down to how hard I tried.

Because I so desperately was like, please, not abstinence, not AA again, you know. And there wasn't a lot of option besides AA 15 years ago, at least in Columbus, Ohio, right? And it didn't work for me. And I saw in moderation management, a lot of people like me who were people who needed abstinence, who were kind of hanging on to that idea. And so, I think that's partially why the moderation debate gets so heated is because for people who need abstinence, I'm a little frightened by the moderation conversation, to be honest, because a little part of me wakes up and goes, see, maybe it could be you. And so I think that's why it's a difficult conversation. How do you feel

about it on a personal level? Yeah, I had to write 300 pages before I got to a point where I was comfortable engaging with it. That was part of the arc of the book was trying to make sense of my felt sense that I am a person in recovery from addiction, that there's something special about that, that I have membership and that I qualify to be in this certain tribe or group of people, and at the same time, that there's no essential division between addiction and the rest of the population. So how do I make sense of that? And the moderation piece goes along with that question, because if I'm not uniquely disordered in some way that crosses a very defined us-them line, then there's no absolute law that says that I can or

can't drink again. For me, I feel like it's enough. I've got enough data and I'm not 100% sure. I'm not 100% sure that I could never drink again safely, but it's not worth it to me. It really isn't. What would I actually get from that experiment? What am I hoping to get out of it? And in fact, you know, one of the gifts of recovery for me was that I got back to something I had a real yearning for earlier in my life, but then addiction pushed me away from, which was Buddhist practice, specifically Zen practice. And I could never commit to it because, you know, I would do a three-week silent retreat and then I would leave and go straight to the bar.

Yeah. Just eradicate all of the progress I'd made. Couldn't wake up on a Saturday morning to get to the Zen center because I was too hung over or whatnot. As a totally separate system of spiritual practice, there are precepts about taking intoxicants. And there are precepts that caution people to be really attentive to the cause and effect of what happens when I take intoxicants. And it's very similar to what happens when I engage in anger. Very similar to what happens when I engage in gossip. You know, these are similar precepts in that moral and ethical code. Again, I'm not a Buddhist teacher, but as I understand it, it's not to say thou shalt not, it's to say, pay attention and see what it's like

when you do this, when you do that. And it's about training the mind. do this when you do that. And it's about training the mind. So I'm at a place right now where I don't stress about it too much. I don't see much of an advantage to intoxication. As a matter of fact, it takes me away from what one of my main purposes of spiritual practice is as far as I understand it. And I share your fear that by talking about moderation, maybe somebody gets misled and they say, hey, some doctor said on some podcast that some people can drink moderately, maybe I'll try it. And then they go out and they overdose because the supply is totally contaminated with fentanyl and whatnot. But we can't deny reality. The fact of the matter is back to the 1970s, we had these studies saying that some people, even with severe substance use problems, can return to moderation. And I think that the forces

that try to suppress and muddy up those waters, in some cases by outright suppressing those reports, they did more harm than good. We're engaged in a scientific process of trying to understand psychology. We can't fight that. That's reality. You talked about the risk of it. It made me think of Pascal's wager, which is the basic idea of like, well, if I don't believe in God, what do I get? Well, I get to maybe, you know, act bad a couple more times. And, you know, but if I'm wrong about this, if I say God doesn't exist and I'm wrong, I'm talking about eternal infinity of damnation. Like, okay, it makes sense to believe. And, you know, moderation is a similar thing for me is, is that idea of like, like you said, what's the benefit? I know what the downside of it is. I've seen what it does to my life. I actually also have the additional benefit of, you know, I got sober, stayed sober eight years and then bought the moderation thing for myself. I was like, well, you know, I was 24 back then I was doing heroin, which we can all agree is a bad idea. I was like, well, you know, I was 24 back then. I was doing heroin, which we

can all agree is a bad idea. I've been to a ton of therapy since then. Like, I think I can make good choices about it. And it turned out I couldn't. So I've already done that once, which helps me a little bit. Let's talk about Zen for a minute, because I'm sort of on a Zen hiatus at the current moment, but have been a pretty dedicated zen practitioner at different points. Is that what you're still doing is zen practice? And if so, what's the lineage? I'm curious. It's Soto Zen. Okay. The Brooklyn Zen Center that I fell into, for lack of a better term, is in the same lineage as the San Francisco Zen Center from Shinryu Suzuki. And I loved it. It was what I needed. I started off Zen practice in Korea right after college and also a very lovely style of practice, but it was very tough. Lots of

bows, sitting very rigidly, a lot of banging sticks on the ground. Sometimes they bang the sticks on your shoulders in a nice way and with people's permission, it wasn't abusive. But that was too much for me. That for me fed into, I mean, the tougher model of Zen practice, it fed into my perfectionistic notion that I should do it all perfectly and I should hold myself rigidly and it's all about me, me, me, control, control, control. And the kind of spiritual practice I needed, because I bounced around a little bit in recovery and otherwise, sampling different traditions. What I needed was sometimes Soto Zen is called Farmer Zen, because it's very gentle. Because it's about, as far as I understand it, again, not a teacher, but it's about just sitting and being with reality as it presents. And one of the fundamental instructions is sit on a cushion and think not

thinking. How do you think not thinking? Not thinking. So just take it easy, man, is the way I interpret that. And I needed that kind of like sympathetic and calm self-care. And the other thing about Soto Zen that I really like, at least in the tradition and with the teachers that I have a good fortune of encountering, is a real focus on ethics and not just meditation as the sole aim and purpose, but how is spiritual practice connected in a community? And that's something I got out of recovery too, just the absolute necessity of recovering together and each other's practice as a mirror for one another. And it's been really supportive. And in Portugal, there's a Great Zen Center and a different lineage have started to go.

Don't know Portuguese yet all that well. So, I'm getting there. But it's such a gift to be able to sit in community with other people. Yeah. My tradition is white plum. So, it's sort of a Rinzai-Soto combination. Taizumi Roshi was a contemporary of Suzuki Roshi who started San Francisco Zen Center. He's one of the only people that had a lineage holder in both Rinzai and Soto. So it's sort of a blend. You said something in the book about at your Buddhist center, you noticed they hosted addiction recovery meetings in a different mutual help tradition that you started going to. And you've got a beautiful line. You said, I needed to find a different framework than the one initially offered to me. I think you mean different than

12 step. Only then did I get a taste of the relief these AA members had described to me earlier, the feeling of being held by the earth and by something larger than myself, something that could help me make sense of suffering and be of purpose in the world. That's such a great summation of what mutual help groups can give us when they're right. Thank you. I meant it. I've seen people connect with that feeling, the leap of faith, the connection with the earth, and the profound happiness and joy that can come from being of meaningful service in the world. And for many people, I think they need to try different varieties. I didn't know that there were different varieties of mutual help meetings.

I fell into it by accident. Again, this is after med school, during residency, and all the rest. And like you, I tell people, try a bunch of different meetings. And that means try a bunch of different AA meetings. But I think it's also useful for people to try a bunch of different recovery mutual help traditions. There's smart recovery, there's a Buddhist recovery network, there are Christian-based ones, so forth and so on. There's so many different varieties now. And there's so much more accessible now that everyone has developed Zoom platforms or other sort of online platforms for connecting. I just think that's a really powerful and hopeful element of recovery today. Yeah, I agree. I think it's a beautiful thing. I don't attend 12-step groups anymore. Occasionally, and I occasionally go to like a Dharma recovery meeting.

I've been getting community in different places in different ways. But I'm so glad to see all the different things that are there. And part of me wonders like, what would I have been drawn to if I was coming in now? Because it's a different world than it was in 1994 in Columbus, Ohio. Like, it's just so different. Anyway, I want to wrap up with a line that I just think we could summarize all of this with. And you say, how do people change?

There is as many answers as there are people in recovery. The key is to try. I think that's the hopeful message, right? Is if you're in recovery or trying to get in recovery, try and keep trying. Yeah, there's so many ways that people have recovered even across the years. That was one of the big gifts of the book too, is to see all the different models and the different varieties that people have happened upon, whether it's spiritual practice or other community-based support or otherwise. And that was daunting when I first started looking into

the history of addiction, but it also gave me tremendous hope and a real sense of fellowship, just that we're part of this human project of trying to better understand the self so that we can live in harmony with ourselves and other people. And if anybody tells you they've got the answer for that, then run screaming in the opposite direction because they're obviously full of crap. Yeah, they've got the only answer for it. Yeah, absolutely. Carl, we are at the end of our time. As I said, I absolutely love the book.

If you are interested in addiction and recovery, I highly recommend it. I absolutely love the book. If you are interested in addiction and recovery, I highly recommend it. You and I are going to continue in a post-show conversation where we are going to talk about Synanon, which is a crazy cult and its impacts in recovery and treatment today. And I love the fact that the founder had to be carried out on, uh, Chivas Regal because he was so drunk, but we'll get to that in the post-show conversation. Listeners, you can get the post-show conversation by going to whenyoufeed.net slash join, becoming a supporter. You get post-show conversations, ad-free episodes,

a special episode I do called Teaching Song and a Poem, and the joy of supporting something that you love. So whenyoufeed.net slash join. Thanks again, Carl. It is such a pleasure to have been talking with you. Pleasure's all mine, Eric. Great to meet you. If what you just heard was helpful to you,

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